House continues to tweak ACA replacement to bring conservative and moderate members on board

The push and pull between conservative and moderate Republicans continues as Congress tries to craft an Affordable Care Act replacement bill that can get enough votes from both groups to pass.

One major sticking point is protections for people with preexisting conditions. It’s becoming increasingly popular with the public and moderate Republican representatives, but not with conservatives, who scuttled the vote for the first iteration of the American Health Care Act (AHCA).

Now Rep. Fred Upton, R-Mich., a centrist who has resisted endorsing the AHCA, is crafting an amendment with the backing of party leaders that “could gain crucial support for the languishing measure,” the Associated Press reported.

It would provide $8 billion over five years to help protect people who had a gap in coverage from facing higher costs due to a preexisting condition. Changes to the bill will go public this week, two senior officials told Politico, but they "can't be that significant, or we will lose the support from the Freedom Caucus," one said.

An amendment floated last week by Rep. Tom MacArthur, co-chair of the moderate Tuesday Group, and Rep. Mark Meadows, chairman of the conservative Freedom Caucus, tried to give states flexibility by allowing them to opt out of one ACA provision that protects those with preexisting conditions from being charged higher premiums. That may have won over conservatives—but it lost many of the moderates.

On Tuesday, House Speaker Paul Ryan came to the defense of the MacArthur amendment, saying it’s “verified” that it protects preexisting condition coverage.

“Under no circumstance can people be denied coverage because of a preexisting condition,” Ryan said in a statement. “Current law prohibiting pricing customers based on health status remains in place and can only be waived by a state if [it takes] care of the people through other risk-sharing or reinsurance mechanisms.”

If a state gets a waiver, “no person may be priced based on health status if they have maintained continuous coverage,” according to Ryan. “In addition to these protections, the AHCA provides significant resources at the federal and state level for risk-sharing programs that lower premiums for all people.”

Whip counts by various news outlets reveal a razor-thin margin: Twenty moderates have vowed to vote “no,” with many more undecided. It would only take three of the latter group flip to “no” to stall the bill for a second time. Meanwhile, the Senate is unlikely to fully embrace any bill that passes the House.